Relief of Malignant Obstructive Jaundice by Percutaneous Insertion of a Permanent Prosthesis in the Biliary Tree

Abstract

Twelve patients with malignant obstruction of the biliary tree were treated by dilating the lesion percutaneously and inserting an internal large-bore teflon prosthesis in place bridging the the stricture. All 12 patients had unresectable neoplasms. The procedure was devised because existing modes of palliation using surgical techniques are associated with significant mortality or mobidity. There are also many problems with nonsurgical catheter drainage. Decompression was achieved in all 12 patients as shown radiographically by passage of contrast into the duodenum. Disappearance of pruitus was achieved in seven of seven patients, and in 10 of 12 disappearance of jaundice (bilirubin, before prosthesis, 18.4 +/- 4.5 mg/dl [mean +/- 1 SD], bilirubin 1 month after prosthesis, 1.8 +/- 0.6 mg/dl [mean +/- 1 SD], P less than 0.001) with improvement of general clinical status was achieved. Percutaneous placement of a permanent biliary tract prosthesis is safe and effective for the palliative decompression of malignant biliary tract obstruction.

Relief of Inoperable Malignant Obstructive Jaundice following the Conversion of Percutaneous Transhepatic Bile Drainage to Internal Drainage

“…An endoprosthesis, placed into the stenotic bile duct for per manent drainage of the biliary system into the duode num may be an excellent procedure for palliation of malignant obstructive jaundice because it does not re quire a draining catheter, a bile bag, bile leakage, foul odors, or skin problems. The advantages of the method, however, may be offset by the recurrence of the bile obstruction [7][8][9] after internal drainage. Burcharth et al [10] reported 7 stent patients among 134 suffering from cholangitis, while Dooley et al [11] had only one stent out of 31 patients with cholangitis.…”

A tree grows in the liver, and now we can see it†

“…52 The percutaneous transhepatic route was used early on for external drainage of obstructive lesions 53 and for the placement of endoprostheses. 54 Biliary ascariasis can be treated, 55 endoscopic sphincterotomy can be done, 56 intrahepatic stones can be cleared 57 and strictures can be dilated by the transhepatic route. 58 More recent developments have been the design of electrolytic stents that generate their own electrical current to inhibit tumor growth 59 or self-destruct.…”

Insertion of a biliary endoprosthesis using a balloon dilatation catheter

“…Although significant acute complications following stent placement are rare, problems associated with long-term catheter drainage occur more often [3]. The use of a permanent internal endoprosthesis instead of an external biliary catheter has been limited until recently, because of problems with stent migration and obstruction [4][5][6][7][8]. The availability of largebore, long biliary stents has reduced both these complications, making this technique an acceptable method for nonoperative drainage of obstructive jaundice [6,9,10].…”